Office visit, patient in rehab, medicare denies claim; why?

ktews

Contributor
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0
Patient was seen in April 2016, presenting to our GI office for GI complaints. At that time the patient was temporarily residing in a rehabilitation facility for a recent fall (completely unrelated to GI and Patient has never been in our GI clinic before). Medicare denied the claim, stating the patient was "inpatient" status and was therefore not eligible to receive office visit benefits. Is there a modifier or something we can do different to get the claim paid (Medicare originally paid but then took the payment back and denied the claim in October 2016). Any guidance would be greatly appreciated. If it helps, we are in CO.
 

mitchellde

True Blue
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13,537
Location
Columbia, MO
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2
You should have used POS for the rehab facility such as 51 or 21 forvwhat the appropriate POS is for where the patient was brought to your offic from. If you submitted the claim with POS 11 this is why it denied.
 
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